Wednesday, June 29, 2011

Change You Can Count On: Insurers Buying Hospitals

If state and federal regulators sign off on the plan, Highmark officials say the deal will allow them to move away from traditional fee models that reward providers for providing unnecessary procedures and services.

Instead they would pay salaries to doctors, offering them incentives to achieve quality and efficiency goals. The integrated model would also rely on primary-care doctors to coordinate patients' care and focus on preventive efforts.

Highmark officials said the deal is the best way to keep West Penn in business. "It brings our expertise as an insurance company into the provider system," said Kenneth R. Melani, Highmark's chief executive.

Add to this that the Accountable Care Act and its Accountable Care Organization construct virtually requires all doctors to become employees of hospitals, we see there is little chance that independent private practices can survive much longer. So doctors lose more professional independence and autonomy and have even more chance that clinical decisions will be compromized by bureaucratic dictates. Yet ask patients who they want steering the boat when they get sick: their doctor.

It continues to be clear who the winners and losers are as health care reform unfolds. But when doctors lose autonomy, patients lose autonomy.

It's that simple.

To argue that the only way to control the health care dollar is to bloat the bureaucratic levels of our system is a fool's game. However, bureaucrats promote bureaucrats - it's always been this way. Until doctors and the public speak up, there's simply nothing to stop this train.

3 comments:

Keith
said...

It seems to me that the reason for physicians having to link up with hospitals boils down to constraints to competition and, of course, money. The need for specialists such as yourself to have those facilities that are needed for you to ply your skills is requiring ever deeper pockets. While physicians should probably not be running the buisiness side of these organizations, they could have posititoned themselves more as dictating to management rather than visa versa. Seemingly the need to get on with making some real money after several years of relative poverty drives the decision to go work for the "man" as well.

Maintaing autonomy for physicians is important. Once gainfully employed, one is somewhat muzzled in what negative criticism a physician can make of their employer. Something I am sure you pay attention to when writing your blog is not to step on the toes of your check writing institution. Unfortunately the major money flows to hospitals who are using their extra dollars to capture physicians and referrals to their hospital. Makes you indeed wonder what is the difference between physicians who own a hospital and those who's ordering and referrals are not too subtlely required to be sent only in house.

Healthcare is "simple"? Huh?Just leave it between a doc and his patient? OK. Now who is going to pay that doc? Now who is going to run NIH? Now who is going to build that artifical heart, develop that drug, administrate that hospital, run that free clinic, make sure that new drug doesn't cause your newborn to be born without arms,research AIDS, protect your food? It hasn't been between a doc and a patient since 1860. It's a large part of our GDP and a large part of our citizenry cannot afford it. A large part of the world covers all of its citizens and outdoes us in many measurments.

"A large part of the world covers all of its citizens and outdoes us in many measurments [sic]."Germany has had socialized medicine for decades. One of the biggest economic problems Germany has- the cost of their health care! Why don't you skip on down to Venezuela... no...maybe Cuba (that's where Chavez is in critical condition) or England for your health care. Of course, you may not be able to get a hospital bed for your care in England since they have only 49% of the beds they had after WWII! Of course we could de-develop medicine just like the environmentalists want to de-develop society, and get rid of the technology and expensive medicines. We could go back to a life expectancy decades shorter than what we are up to presently. No matter where you are in the developed world, medical care costs a lot! The only way to decrease its cost significantly is to do less care. You can use rationing, decreasing the number of beds and facilities, cutting off access to medicines and technologies. Pick your poison! Would you rather make those decision with your doctor or your government? Your government only cares about saying that your covered. Coverage ≠ treatment. I hope I'm around to see some of you get that for which you're asking!

About Me

Westby G. Fisher, MD, FACC is a board certified internist, cardiologist, and cardiac electrophysiologist (doctor specializing in heart rhythm disorders) practicing at NorthShore University HealthSystem in Evanston, IL, USA and is a Clinical Associate Professor of Medicine at University of Chicago's Pritzker School of Medicine. He entered the blog-o-sphere in November, 2005.
DISCLAIMER: The opinions expressed in this blog are strictly the those of the author(s) and should not be construed as the opinion(s) or policy(ies) of NorthShore University HealthSystem, nor recommendations for your care or anyone else's. Please seek professional guidance instead.